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NPI Code Detail

MEDICARE: JACOB JOSLYN

MEDICARE: JACOB JOSLYN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianMN

General Provider Information

NPI Number : 1295446052
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB JOSLYN
Provider Business Mailing Address
First Line : 1517 24TH AVE N APT 20
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-1280
Country : US
Telephone Number : 320-630-0639
Fax Number :
Provider Business Practice Location Address
First Line : 226 PARK AVE S
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56301-3713
Country : US
Telephone Number : 320-301-0039
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2022
Last Update Date : 04/08/2026

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Directions to “ JACOB JOSLYN ” Practice Location

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